Provider Demographics
NPI:1912101015
Name:JULIE RALLS, M.D., INC.
Entity Type:Organization
Organization Name:JULIE RALLS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:RALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-646-3316
Mailing Address - Street 1:2011 WESTCLIFF DR STE 4
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5508
Mailing Address - Country:US
Mailing Address - Phone:949-646-3316
Mailing Address - Fax:949-646-1310
Practice Address - Street 1:2011 WESTCLIFF DR STE 4
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5508
Practice Address - Country:US
Practice Address - Phone:949-646-3316
Practice Address - Fax:949-646-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63700261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA--G637001Medicaid
CA--G637001Medicaid
CAF18559Medicare UPIN